Acute coronary syndrome after cannabis use: Correlation with quantitative toxicology testing
We report the first ever published case of ACS precipitated by cannabis use that was confirmed with concomitant rising quantitative plasma levels of 11-nor-9-carboxy- Δ9-tetrahydrocannabinol, a secondary metabolite of cannabis. A 63-year-old non-tobacco smoking male with no prior medical history presented to the emergency department with chest pain immediately after smoking cannabis, and anterior ST-segment elevation pattern was observed on his electrocardiogram . (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 13, 2019 Category: Emergency Medicine Authors: John R. Richards, Gagan D. Singh, Aman K. Parikh, Sandhya Venugopal Source Type: research

Traumatic coronary artery dissection leading to ventricular tachycardia: A case report
We present a case report of a 42-year-old male who presented with ventricular tachycardia following a high-speed motorcycle collision that was found to have a coronary artery dissection. The patient had multiple complications, highlighting the importance of early recognition. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 13, 2019 Category: Emergency Medicine Authors: Andrew E. Donovan, Rachel E. Bridwell, Brandon Carius, Chloe Kot, Joshua J. Oliver Source Type: research

Traumatic coronary artery dissection leading to ventricular tachycardia
We present a case report of a 42-year-old male who presented with ventricular tachycardia following a high-speed motorcycle collision that was found to have a coronary artery dissection. The patient had multiple complications, highlighting the importance of early recognition of this disease process. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 13, 2019 Category: Emergency Medicine Authors: Andrew E. Donovan, Rachel E. Bridwell, Brandon Carius, Chloe Kot, Joshua J. Oliver Source Type: research

Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome
HELLP (hemolysis, elevated liver enzyme levels, low platelet counts)-syndrome is a rare but dramatic pregnancy-related illness. The difficult part of this syndrome is the lack of standardised diagnostic criterias and tests to be used to predict it. The aim of this study is determining the role of APRI score in the diagnosis of HELLP syndrome. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 12, 2019 Category: Emergency Medicine Authors: Muhammed İkbal Şaşmaz, Muhammed Ali Ayvaz, Ahmet Cumhur Dülger, Eylem Kuday Kaykısız, Ramazan Güven Source Type: research

Nursing driven approaches to improving emergency department discharge
Emergency departments (EDs) are critiqued for wait times, delayed or inadequate pain management, and poor communication [1-3]. ED volumes are projected to increase, likely exacerbating these issues [4,5]. Systems are increasingly relying on EDs to provide not only high-quality clinical care, but also to promote the patient experience [1,6-8].The overlap between efficiency, quality of care and patient satisfaction is significant [3,7,9]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 12, 2019 Category: Emergency Medicine Authors: Anish K. Agarwal, Sean Foster, Carolina Garzon Mrad, Brooks Martino, Christopher K. Snider, Leighann Mazzone, Allen Fasnacht, Kelly Patton, Christopher Edwards, John Flamma Source Type: research

Implications of culture collection after the first antimicrobial dose in septic emergency department patients
Previous research has illustrated the importance of collection of microbiologic cultures prior to first antimicrobial dose (FAD) in septic patients to avoid sterilization of pathogens and thus allowing confirmation of infection, identification of pathogen(s), and de-escalation of antimicrobial therapy. There is currently a lack of literature characterizing the implications and clinical courses of patients who have cultures collected after FAD. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 12, 2019 Category: Emergency Medicine Authors: Vincent J. Cascone, Rose S. Cohen, Nicholas P. Dodson, Chad M. Cannon Source Type: research

Ultrasound guided supra-inguinal Fascia Iliaca Compartment Blocks in hip fracture patients: An alternative technique
The objective was to determine analgesic effects of an ultrasound-guided supra-inguinal FICB in hip fracture patients in the Emergency Department. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 11, 2019 Category: Emergency Medicine Authors: M.L. Ridderikhof, E. De Kruif, M.F. Stevens, H.M. Baumann, P.B. Lirk, J.C. Goslings, M.W. Hollmann Source Type: research

Flexible nasotracheal intubation compared to blind nasotracheal intubation in the setting of simulated angioedema
Nasotracheal intubation is rarely performed in the emergency department (ED) but may be required in specific situations such as angioedema. Both blind and flexible nasal intubation (FNI) may be utilized; however, the preferred technique is unknown. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 11, 2019 Category: Emergency Medicine Authors: Seth Parkey, Thomas Erickson, Emily M. Hayden, Calvin A. Brown III, Jestin N. Carlson Source Type: research

A case of purulent pneumococcal pericarditis
Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 11, 2019 Category: Emergency Medicine Authors: Itay Zmora, Yonit Wiener-Well, Evan Avraham Alpert Source Type: research

Hyperbaric oxygen therapy and mortality from carbon monoxide poisoning: A nationwide observational study
We examined the effects of HBOT on CO poisoning and further strived to delineate its inherent effects on specific subgroups of patients using a nationwide inpatient database. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 10, 2019 Category: Emergency Medicine Authors: Mikio Nakajima, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga Source Type: research

Asking the correct questions of push dose vasopressors
I read with interest the article published by Rotando and colleagues entitled “Push dose pressors: Experience in critically ill patients outside of the operating room” [1]. Research regarding the efficacy of bolus or “push dose” vasopressors important and more research is necessary. The results of trial merit further discussion, particularly those pertaining to push d ose phenylephrine. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 8, 2019 Category: Emergency Medicine Authors: Nicholas Farina Source Type: research

The Ottawa subarachnoid hemorrhage clinical decision rule for classifying emergency department headache patients
Subarachnoid hemorrhage (SAH) is a serious cause of headaches. The Ottawa subarachnoid hemorrhage (OSAH) rule helps identify SAH in patients with acute nontraumatic headache with high sensitivity, but provides limited information for identifying other intracranial pathology (ICP). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 7, 2019 Category: Emergency Medicine Authors: Wei-Ting Wu, Hsiu-Yung Pan, Kuan-Han Wu, Yi-Syun Huang, Chien-Hung Wu, Fu-Jen Cheng Source Type: research

Lactate and NEWS-L are fair predictors of mortality in critically ill geriatric emergency department patients
In this study, we aimed to investigate the prognostic power of the first lactate level measured in the emergency department (ED), National Early Warning Score (NEWS), and NEWS-lactate (NEWS-L) on ED admission in critically ill geriatric patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 7, 2019 Category: Emergency Medicine Authors: Zerrin Defne Dundar, Sedat Kocak, Abdullah Sadik Girisgin Source Type: research

Emergency department sepsis huddles: Achieving excellence for sepsis benchmarks in New York State
The sepsis order set at our institution was created with the intent to facilitate the prompt initiation of appropriate sepsis care. Once clinical features meeting criteria for systemic inflammatory response syndrome (SIRS) are identified and an infectious source is considered, a “sepsis huddle” is concomitantly initiated. The sepsis huddle was implemented in March of 2016 in order to increase compliance with the sepsis bundles. The sepsis huddle is called via overhead paging system in the emergency department (ED) to notify all staff that there is a patient present who meets SIRS criteria with concern for sepsi...
Source: The American Journal of Emergency Medicine - February 7, 2019 Category: Emergency Medicine Authors: Danielle Walsh, Robert Gekle, Robert Bramante, Eric Decena, Christopher Raio, David Levy Source Type: research

The impact of an emergency care access point on pediatric attendances at the emergency department: An observational study
Crowding is a growing concern in general and pediatric Emergency Departments (EDs). The Emergency Care Access Point (ECAP) - a collaboration between general practitioners and the ED - has been established to reduce the number of self-referrals and non-urgent ED visits. The aim of this study was to determine the impact of an ECAP on pediatric attendances in the ED. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 6, 2019 Category: Emergency Medicine Authors: Mireille E.M. Platter, Roel A.J. Kurvers, Loes Janssen, Marjoke M.J. Verweij, Dennis G. Barten Source Type: research

Heart rate variability in patients presenting with neurally mediated syncope in an emergency department
In this study, we investigated the pathophysiology of NMS using HRV in our emergency department. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 6, 2019 Category: Emergency Medicine Authors: Hikaru Akizuki, Naoyuki Hashiguchi Source Type: research

Intravenous dexketoprofen versus paracetamol in non-traumatic musculoskeletal pain in the emergency department: A randomized clinical trial
This study sets out to compare the effectiveness of intravenous dexketoprofen and paracetamol in musculoskeletal pain relief. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 4, 2019 Category: Emergency Medicine Authors: Ezgi Demirozogul, Atakan Yilmaz, Mert Ozen, Ibrahim Turkcuer, Murat Seyit, Cuneyt Arikan Source Type: research

Ultrasound and optic neuritis
We were really interested in the paper by Yee et al. concerning four patients with optic neuritis, diagnosed with ultrasound [1]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 4, 2019 Category: Emergency Medicine Authors: Palmiro Cornetta, Giuseppe Marotta, Maddalena De Bernardo, Livio Vitiello, Nicola Rosa Source Type: research

Diagnostic considerations in detecting apical hypertrophic cardiomyopathy while utilizing point-of-care ultrasound
The emergency department (ED) clinical approach to patients with unexplained syncope has ushered in an era of advances in the point-of-care ultrasound (POCUS) practice. Cardiac ultrasound (US) is a key application that is often utilized in young patients with syncope when screening for structural abnormalities such as hypertrophic cardiomyopathy (HCM). The application of the cardiac US for this screening, however, can be hindered by phenotypic variability of hereditary HCM. The apical variant of HCM constitutes a minority of all cases ( (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - February 1, 2019 Category: Emergency Medicine Authors: Melanie F. Molina, Andrew S. Liteplo, Calvin Huang, Hamid Shokoohi Tags: Correspondence Source Type: research

Pre-hospital modified shock index for prediction of massive transfusion and mortality in trauma patients
Modified shock index (MSI) is a useful predictor in trauma patients. However, the value of prehospital MSI (preMSI) in trauma patients is unknown. The aim of this study was to investigate the accuracy of preMSI in predicting massive transfusion (MT) and hospital mortality among trauma patients. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 31, 2019 Category: Emergency Medicine Authors: Il-Jae Wang, Byung-Kwan Bae, Sung-Wook Park, Young-Mo Cho, Dae-Sup Lee, Mun-Ki Min, Ji-Ho Ryu, Gil-Hwan Kim, Jae-Hoon Jang Source Type: research

Nurse practitioners and physician assistants in emergency medical services who billed independently, 2012 –2016
As nurse practitioners (NPs) and physician assistants (PAs) become an integral part of delivering emergency medical services, we examined the involvement of NPs and PAs who billed independently in emergency departments (EDs). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 31, 2019 Category: Emergency Medicine Authors: Ge Bai, Gabor D. Kelen, Kevin D. Frick, Gerard F. Anderson Source Type: research

Lev's Syndrome: A rare case of progressive cardiac conduction disorder presenting to the emergency department
Lev's Syndrome is a rare, progressive cardiac conduction defect (PCCD) due to myocardial fibrosis first described by Maurice Lev in 1964. This condition, proposed to start in the fourth decade of life, involves a sclerotic fibro-fatty degeneration of the Bundle of His and Purkinje fibers, which Lev proposed caused increasing AV delay with age. With the prevalence of electrocardiogram (ECG) use in the emergency department (ED) for cardiac- and non-cardiac complaints, dysrhythmias can be incidentally found and confuse diagnosis and disposition. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 31, 2019 Category: Emergency Medicine Authors: Brandon Carius, Brit Long, Steve Schauer Source Type: research

Traumatic cerebrovascular injury: Prevalence and risk factors
Traumatic cerebrovascular injury (TCVI) is uncommon in traumatic brain injury (TBI). Although TCVI is a rare condition, this complication is serious. A missed or delayed diagnosis may lead to an unexpected life-threatening hemorrhagic event or persistent neurological deficit. The object of this study was to determine the prevalence and risk factors associated with TCVI. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 31, 2019 Category: Emergency Medicine Authors: Thara Tunthanathip, Nakornchai Phuenpathom, Sakchai Saehaeng, Thakul Oearsakul, Ittichai Sakarunchai, Anukoon Kaewborisutsakul Source Type: research

Single dose phenobarbital in addition to symptom-triggered lorazepam in alcohol withdrawal
The purpose of this study was to evaluate the safety and efficacy of a single parenteral dose of phenobarbital in addition to symptom-triggered lorazepam for the acute management of alcohol withdrawal syndrome (AWS). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 30, 2019 Category: Emergency Medicine Authors: Francisco Ibarra Source Type: research

Comparison of intravenous lidocaine/ketorolac combination to either analgesic alone for suspected renal colic pain in the ED
To compare analgesic efficacy and safety of intravenous lidocaine and ketorolac combination to each analgesic alone for ED patients with suspected renal colic. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 29, 2019 Category: Emergency Medicine Authors: Sergey Motov, Catsim Fassassi, Jefferson Drapkin, Mahlaqa Butt, Rukhsana Hossain, Antonios Likourezos, Ralph Monfort, Jason Brady, Nechama Rothberger, Stefan S. Mann, Peter Flom, Vishal Gulati, John Marshall Source Type: research

Comparing intravenous lidocaine/ketorolac combination to either analgesic alone for suspected renal colic pain in the ED
To compare analgesic efficacy and safety of intravenous lidocaine and ketorolac combination to each analgesic alone for ED patients with suspected renal colic. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 29, 2019 Category: Emergency Medicine Authors: Sergey Motov, Jefferson Drapkin, Mahlaqa Butt, Catsim Fassassi, Rukhsana Hossain, Antonios Likourezos, Ralph Monfort, Jason Brady, Nechama Rothberger, Stefan S. Mann, Peter Flom, Vishal Gulati, John Marshall Source Type: research

Descriptive study of drug-drug interactions attributed to prescriptions written upon discharge from the emergency department
The primary purpose of this study was to identify the most common drug-drug interactions (DDI'S) in patients prescribed medications upon discharge from the emergency department. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 29, 2019 Category: Emergency Medicine Authors: Tara Jawaro, Patrick J. Bridgeman, Jude Mele, Grant Wei Source Type: research

Effect of insonation angle on peak systolic velocity variation
As point of care ultrasound (POCUS) has become more integrated into emergency and critical care medicine, there has been increased interest in utilizing ultrasound to assess volume status. However, recent studies of carotid POCUS on volume status and fluid responsiveness fail to recognize the effect insonation angle has on their results. To address this, we studied the effect of insonation angle on peak systolic velocity (PSV) change associated with respiratory variation (RV) and passive leg raise (PLR). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 29, 2019 Category: Emergency Medicine Authors: Joshua R. Radparvar, George Lim, Alan T. Chiem Source Type: research

Approach to cardiopulmonary resuscitation induced consciousness, an emergency medicine perspective
Cardiopulmonary resuscitation (CPR) remains the key intervention following cardiac arrest because of its ability to continue circulation. Recent focus on high quality compressions during CPR has coincided with more frequent encounters of CPR Induced Consciousness (CPRIC). CPRIC represents a poorly understood patient experience during CPR and defined as signs of consciousness and pain perception during CPR. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 29, 2019 Category: Emergency Medicine Authors: A. Pourmand, B. Hill, D. Yamane, E. Kuhl Source Type: research

Emergency physician care of family members, friends, colleagues and self
Emergency Physicians are frequently called upon to treat family members, friends, colleagues, subordinates or others with whom they have a personal relationship; or they may elect to treat themselves. This may occur in the Emergency Department (ED), outside of the ED, as an informal, or “curbside” consultation, long distance by telecommunication or even at home at any hour. In surveys, the vast majority of physicians report that they have provided some level of care to family members, friends, colleagues or themselves, sometime during their professional career. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 26, 2019 Category: Emergency Medicine Authors: Joel M. Geiderman, Catherine A. Marco, Kenneth V. Iserson Source Type: research

Ultrasound-guided transverse abdominis plane block for ED appendicitis pain control
The ultrasound-guided transversus abdominis plane (TAP) block or TAP block is a well-established regional anesthetic block used by anesthesiologists for peri-operative pain control of the anterior abdominal wall. Multiple studies have demonstrated its utility to control pain for a range of procedures from inguinal hernia repair, laparoscopic cholecystectomies to cesarean sections [1-3]. There are no cases describing the efficacy of the ultrasound-guided TAP block in the emergency department as a part of a multimodal pain pathway for patients diagnosed with acute appendicitis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 25, 2019 Category: Emergency Medicine Authors: Sally Mahmoud, Emily Miraflor, David Martin, Daniel Mantuani, Josh Luftig, Arun D. Nagdev Source Type: research

Editorial Board
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 24, 2019 Category: Emergency Medicine Source Type: research

Table of Contents
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 24, 2019 Category: Emergency Medicine Source Type: research

Info for authors
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 24, 2019 Category: Emergency Medicine Source Type: research

Financial relationships with industry among guideline authors for the management of acute ischemic stroke
To characterize the prevalence of industry relationships among authors of acute ischemic stroke (AIS) guidelines and its association with graded evidence. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 24, 2019 Category: Emergency Medicine Authors: Joshua D. Niforatos, Richard M. Pescatore Source Type: research

Risk factors for seizure recurrence in a pediatric observation unit
Most patients present with seizures to pediatric emergency department (PED) are observed for extended periods for the risk of possible acute recurrence. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 24, 2019 Category: Emergency Medicine Authors: Ayse Gultekingil, Ozlem Teksam, Goknur Haliloglu, Dilek Yalnizoglu Source Type: research

Presentation and management of traumatic occipital spur fracture
We describe an interesting and previously unreported case of fracture of an occipital spur following trauma. Our 20-year-old male patient was treated in the emergency department (ED) and discharged home without complication. Neurosurgical consultation was obtained but is not requisite for these injuries. Greater awareness of this unique presentation may help to expedite future emergency department treatment. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 24, 2019 Category: Emergency Medicine Authors: Mithun Sattur, Clayton Korson, Fraser Henderson, Stephen Kalhorn Source Type: research

Successful distal urethral stone removal in the emergency department
Nephrolithiasis is a common pathology encountered in the primary care and emergency department (ED) setting. In 2009 alone, there were over one million ED visits related to nephrolithiasis Higa et al. (2017) [1]. Emergent treatment options range from non-invasive pain control and patient education to lithotripsy and other invasive urologic procedures depending on stone location and related pathology. Urethral calculi are estimated to represent 0.3% of all urinary stone diseases Verit et al. (2006) [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 24, 2019 Category: Emergency Medicine Authors: Kyle E. Embertson, Diann M. Krywko, Eric R. Bunch Source Type: research

Sensitivity of a bedside reagent strip for the detection of spontaneous bacterial peritonitis in ED patients with ascites
To determine the sensitivity of a highly sensitive bedside leukocyte esterase reagent strip (RS) for detection of spontaneous bacterial peritonitis (SBP) in emergency department (ED) ascites patients undergoing paracentesis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 24, 2019 Category: Emergency Medicine Authors: Brian Chinnock, Robert E. Woolard, Gregory W. Hendey, Scott Crawford, Leann Mainis, Daniel Vo, Radosveta N. Wells, Ren é Ramirez, Deena I. Bengiamin Source Type: research

Usefulness of RBC distribution width and C-reactive protein to predict mortality in pediatric non-cardiac critical illness
We aimed to assess the performance of red blood cell distribution width (RDW), C-reactive protein (CRP) or the combination of both to predict clinical outcomes in pediatric non-cardiovascular critical illness. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 23, 2019 Category: Emergency Medicine Authors: Gang Li, Peng Jia, Jian Zhao, Xingdan Wu, Yan Duan, Dong Liu, Ting Wang, Bin Liu Source Type: research

Ultrasound optic nerve sheath diameter measurement in optic neuritis
We read with great interest the case report written by Yee et al. regarding four cases in which they demonstrated the usefulness of transbulbar ultrasonography in evaluating the optic nerve to identify the presence of optic neuritis [1]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 22, 2019 Category: Emergency Medicine Authors: Maddalena De Bernardo, Livio Vitiello, Nicola Rosa Source Type: research

Which one is more important in traumatic brain injury: Hypotension or hypoxia?
In this study, the authors examined the association between hypoxia level and outcomes according to shock status in traumatic brain injury (TBI) patients. They found that the mortality rates were 49.4% in severe hypoxia, 30.7% in mild hypoxia, 18.5% in normoxia. Mortality rates were 47.1% in TBI patients with shock status and 20.5% in non-shock TBI patients. There was a trend toward worsened outcomes with mild and severe hypoxia in patient with and without shock, however, the only met statistical significance for patients with both severe hypoxia and non-shock status. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 22, 2019 Category: Emergency Medicine Authors: Arsal Acarba ş Tags: Correspondence Source Type: research

Digoxin-specific Fab and therapeutic plasma exchange for digitalis intoxication and renal failure: A case report.
Treatment of chronic digitalis intoxication includes suspension of drug intake, which may be sufficient in case of mild manifestations, and supportive measures. Severe bradycardia requires the administration of atropine or isoproterenol; placement of a temporary pacemaker may be required in case of absent response to pharmacological therapy. Severe and life-threatening manifestations should be treated with digoxin-specific fragment antigen binding antibodies (Fab). Therapeutic plasma exchange has been suggested, in addition to Fab therapy, to maximize the clearance of Fab-digoxin complexes in patients with renal failure. (...
Source: The American Journal of Emergency Medicine - January 22, 2019 Category: Emergency Medicine Authors: Marta Pellegrino, Mattia Garofalo Source Type: research

Extracorporeal cardiopulmonary resuscitation for massive pulmonary embolism in a “hybrid emergency room”
Patients with massive pulmonary embolism (PE) have poor outcomes and their management remains challenging. An interventional radiology (IVR)-computed tomography (CT) system available in our emergency room (ER) allows immediate access to CT and extracorporeal membrane oxygenation (ECMO) with safe cannulation under fluoroscopy. We aimed to determine if initial treatment in this “hybrid ER” is helpful in patients with PE requiring extracorporeal cardiopulmonary resuscitation (ECPR). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 22, 2019 Category: Emergency Medicine Authors: Kazuki Miyazaki, Mayu Hikone, Yusuke Kuwahara, Takuto Ishida, Kazuhiro Sugiyama, Yuichi Hamabe Source Type: research

Digoxin-specific Fab and therapeutic plasma exchange for digitalis intoxication and renal failure
Treatment of chronic digitalis intoxication includes suspension of drug intake, which may be sufficient in case of mild manifestations, and supportive measures. Severe bradycardia requires the administration of atropine or isoproterenol; placement of a temporary pacemaker may be required in case of absent response to pharmacological therapy. Severe and life-threatening manifestations should be treated with digoxin-specific fragment antigen binding antibodies (Fab). Therapeutic plasma exchange has been suggested, in addition to Fab therapy, to maximize the clearance of Fab-digoxin complexes in patients with renal failure. (...
Source: The American Journal of Emergency Medicine - January 22, 2019 Category: Emergency Medicine Authors: Marta Pellegrino, Mattia Garofalo Tags: Case Report Source Type: research

Interexaminer reliability of pharyngeal injection and palatine tonsillar hypertrophy in a pediatric emergency department
To evaluate the interrater reliability of throat examinations in children according to the major and training stage. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 21, 2019 Category: Emergency Medicine Authors: Soyun Hwang, Jae Yun Jung, Joong Wan Park, Do Kyun Kim, Young Ho Kwak Source Type: research

The changing paradigm from subjectivity to objectivity in pupillary assessment during neurological examination
Pupillary assessment beside Glasgow coma scale (GCS) is an important part of neurological assessment because changes in the size, equality and reactivity of the pupils can provide vital diagnostic information in the critically ill and injured patient [1]. Pupil index (NPi) is being used as a sensitive measure of pupil reactivity and an early indicator of increasing intracranial pressure (ICP). Raised ICP may occur in patients with severe traumatic brain injury (TBI), aneurysmal subarachnoid hemorrhage, or intracerebral hemorrhage (ICH) and other acute neurological emergencies [2]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 21, 2019 Category: Emergency Medicine Authors: Priyanka Modi, Sanjeev Bhoi, Praveen Aggarwal, L.R. Murmu, Tej Prakash Sinha, Meera Ekka, Akshay Kumar, Nayer Jamshed Source Type: research

The intensity of pain in the prehospital setting is most strongly reflected in the respiratory rate among physiological parameters
In order to treat pain optimally, the Emergency Medical Service (EMS) clinician needs to be able to make a reasonable estimation of the severity of the pain. It is hypothesised that various physiological parameters will change as a response to pain. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 21, 2019 Category: Emergency Medicine Authors: Andersson Jan-Otto, Nasic Salmir, Herlitz Johan, Hjertonsson Erik, Axelsson Christer Source Type: research

Fasciculating toxicity: A case report
We describe here a case of 19-year old girl who presented to the Emergency Department with atypical features of OP poisoning. She had perioral, tongue and lower limb fasciculations along with generalized muscle weakness with no or minimal muscarinic effects. OP poisoning with isolated nicotinic receptor mediated effect is often reported in children but in adult it is extremely rare. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 21, 2019 Category: Emergency Medicine Authors: Anupam Ranjan, Nayer Jamshed, Praveen Aggarwal, Vibhor Upadhyay Source Type: research

Agreement between arterial and peripheral venous lactate levels in the emergency department: A systematic review
In the Emergency Department, lactate measurement is a useful tool to risk-stratify critically ill patients. However, it is unclear whether arterial or peripheral venous lactate levels can be used interchangeably for this purpose. In this systematic review, we provide an overview of studies investigating the agreement between arterial and peripheral venous lactate levels in the Emergency Department. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - January 21, 2019 Category: Emergency Medicine Authors: A.J. van Tienhoven, C.A.J. van Beers, C.E.H. Siegert Source Type: research